The position was first created by the Maryland Constitution of 1864. Under that system of government, the lieutenant governor served as president of the Senate and would assume the office of governor if the incumbent should die, resign, be removed, or be disqualified.

The state's present constitution, adopted in 1867, abolished the lieutenant governorship. However, the position was re-established by a constitutional amendment ratified on November 3, 1970.

Under the 1970 amendment, the Lieutenant Governor "shall have only the duties delegated to him by the Governor." Maryland's lieutenant governorship is thus weaker than the office in several, but not all, other states that have one. For instance, in many states, including Texas, the lieutenant governor is the president of the state's Senate and in California the Lieutenant Governor assumes all of the Governor's powers when he or she is out of the state. In both of those states, as in some others, the lieutenant governor is elected in his or her own right, independently of the state's governor.

In practice, Maryland's lieutenant governor attends cabinet meetings, chairs various task forces and commissions, represents the state at ceremonial functions and at events with or without the governor, and advises the governor. If the governor dies, resigns or is removed from office (via impeachment), the lieutenant governor becomes governor. A vacancy in the lieutenant governorship is filled by a person nominated by the governor and confirmed by a majority vote of the General Assembly voting in joint session.

As of January 2019[update], there are six former lieutenant governors of Maryland who are currently living at this time, the oldest lieutenant governor of Maryland being J. Joseph Curran, Jr. (served 1983–1987, born 1931). The most recent death of a former lieutenant governor of Maryland was that of Blair Lee III (served 1971–1979, born 1916), on October 25, 1985.